Mucous Cyst Rx

"Its just a local trauma..."
"No, its a bacterial wart! be careful, it infectious...certainly needs a surgery and biopsy..."
"Oh, just a simple mucous cyst!"

Two months, four doctors and three hospitals and many thousand rupees later, we have gained a few insights into the way in which our medical system works. It give you a glimpse of how private medical care is designed to make a mountain out of a molehill, to scare and fleece the gullible.

Two months ago, our son Aki got a cut on his upper lip which, instead of healing, developed into an eruption. Flesh etruded out of the cut which bled profusely from time to time. One day it would seem to be healing with a black scab but return to a a fleshy, bleeding nodule the very next. About 10 days after it showed no signs of healing, we took him to a doctor at the nearby Jaypee Hosptital. The pediatrician said it was just a "local trauma" and prescribed a  an anti-inflamatory syrup.

Aki found the syrup tasty but it nothing to reduce the eruption, or the bleeding. So off we went for a second opinion, to pediatrician at Patparganj, one strongly recommended by doctor-friends. The clinic was crowded and, from the number of vaccine adverts on the walls, quite popular with pharma companies as well. The doctor here came through a fair, honest, consciencious physician. "This looks like a wart", he said, "It needs to be surgically excised...it is just an Out Patient (OP) procedure in any government hospital, but given the crowds, you won't be seen unless you know somebody personally. If you go to any private hosptial, make sure you get the estimates clearly, in writing, before you get the child admitted". He also graciously returned - to our amazement - his consultancy fees (INR500) because, in his words, "I only advised you to go elsewhere." 

Next stop, Max Hospital. Here we got to meet our first pediatric surgeon. One look at Aki's lip, and he declared that it was "mucous cyst". Pulling our a couple of blank sheets, he explained in detail how it developed. "Sometimes, the process of healing ends up blocking the flow of mucus cells...and instead of keeping the lip surface moist, they end up discharging mucus under the skin. This develops into a cyst which ruptures and bleeds easily." Surgery, apparently, was the only way to get the cyst removed.

How much would surgery cost? Well, the answer depends on whether or not you have a mediclaim insurance cover. If you do, then it would cost about INR 25,000 if you got it done at Max Hospital. The cost of booking an operation theatre, anaesthesia specialists and a days' stay at the hospital, we were told, made a relatively simple procedure expensive. 

Would this be defenitely covered under mediclaim? Guys at the billing office were not so sure. "Lets see", they said, "We will submit all the papers and then know in a couple of days". Not quite reassuring.

So now we went for fourth opinion with a surgeon at Kailash Hospital, Noida. The diagnosis at Max was reconfirmed. This certainly was a mucus cyst that needed to be 'surgically excised, or cauterized'. The cost was a couple of thousands less but, given the crowds at this hospital, nobody wanted to an operation date, or the insurance coverage.

Back at Jaypee Hospital, the feedback from the billing office was the same. The procedure would cost not less than INR 25,000, which included no less than INR 8000 for 'micellaneous consumables'! The cost of the biopsy, of course, would be extra.

Since none of the pediatric surgeons said that it was emergency procedure, we thought about it for a couple of days, checked with other hospital, and settled for a surgery at Felix Hospital. This was the only place were we met a pediatric surgeon who inspired confidence in us with his surgery-as-last-resort approach. This was the also only hospital that had an OT readily available, did not insist on conning insurance companies and came up with surgery cost estimates at INR 5500. The only down side at this hospital was that they charged thrice the amount for consultancy fees for pediatric surgeons, compared to far more reputed hospitals. 

Anyway, sometimes when all is not so well also ends well. A supposedly common medical condition was misdiagnosed, received inflated cost estimates for the surgery, and was finally sorted out for one-fifth the estimates. One thing is clear, the nexus between private private, medical insurance companies, and TPAs is designed to fleece patients - especially those who may not have the luxury of time to seek a fair deal.

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Postscript:
After the final follow-up visit, our doctor requested that we evaluate him online. I received three sites on WhatsApp -- Practo, Lybrate and JustDial. This is an interesting new trend - doctors want to create a reputation that is independent of the hospitals in which they serve. I am not sure if this is good for the patients because we now have one more broker in between, and the additional costs are built into the doctor's fees :(

* Practo: Verifies feedback with an OTP sent to mobile number, collects proof of visit (bill/prescription), and creates a login for you, on the sly. 
* Lybrate: Does not have a clear section for doctor feedback. Verified using OTP. No need to login.
* JustDial: Badly designed site. The doctor's review page forces you to post your comments on FaceBook and Twitter (default option). Crazy.

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LINKS:

- Oral mucocele - https://en.wikipedia.org/wiki/Oral_mucocele

Trek to Kaylong Kartik Temple and Kugti Pass

I'm sitting at my desk, with my eyes on a glowing laptop screen, but my mind is still in the Himalayan mountains.

Having spent the whole of last week trekking through the stunning Chamba valley, attempting my first Cross-Over trek through the Kugti Pass to Lahaul-Spiti in Ladakh, I realize that this trip has been an eye-opener is more ways than one.

I did not know, for instance, that affordable trekking was possible for a small group of five, with the support of two guides, one porter and a cook! Since much of the grunt work of setting up camp, cooking food and foraging for fuel is outsourced, it leaves you with enough and more time to take in the scenery, observe the birds and insects, and enjoy the journey.

This trek passed through the Manikaran Kailash area, an ancient pilgrimage circuit. It was therefore not surprising to see the route dotted with tiny roadside shrines and larger temples. What was intriguing, however, was the set of beliefs and traditions that blended so well with that of the nomadic shepherds who form the economic lifeline of this remote district.

The Keylang Kartik Temple is an excellent example. It is open only from 13 April to 30 November every year - the time when the shepherds are taking their flock from their summer grazing grounds in Lahaul-Spiti down the green meadows and fields of the Chamba valley and the plains, to escape the harsh winters in the mountains.

The temple itself is at multiple levels, blending with the steep slope on which it is located. At the lowest area are the toilets, a little further up, attached to the main building is a shop selling votive's and offerings. This shop is run by the same family that takes care of the temple - priests from the Kugti Village. At the next level you have the temple with a large courtyard, attached to a cooking shed and a little spring-water pool purported to contain the footprints of the presiding deity.

The main temple is a wooden structure divided into two areas - a prayer hall with a window on each of its three walls, facing the towering snow-peaks, and the sanctum containing three idols, one each of silver, panchadhatu (?) and marble. As in most North Indian temples, devotees can walk right into the sanctum and touch the idols before going around the narrow passageway surrounding the sanctum.

The evening Aarti takes place at 7 PM. The priest corrals whoever is around to help with the puja. I was handed a Yak-hair fly-whisk while our guide took charge of the cymbals as we walked around clanging numerous bells hanging overhead. We all then stepped out to offer prayers to two more deities in the courtyard area - Ganesha and Kartik again represented by his vaahana, the peacock.

One thing you will not miss at the temple is the iron chains and tridents along the temple walls. While most of the tridents / trishuls are offerings from the pilgrims on the Manikaran Kailash circuit, the chains are more than just symbolic. They are used by soothsayers from the nearby villages to flagellate themselves as they go into a frenzy while "talking" to the mountain spirits. They become the medium through which the Gods speak to the villagers, and vice versa.

According to the temple priest, the older chains are considered more potent by the villagers. If they need to borrow the older chains to be used in the village temples, they have to deposit two new ones as security. Also, a chain borrowed from the temple is to be carried "without touching the ground", even if it is tucked away inside a bag.

Animal sacrifice is the most accepted form of thanksgiving here. Villagers and shepherds come here to offer animals in gratitude for a successful crossing, or after surviving another winter in the mountains. Perhaps quite appropriately, the main prasad here is mutton-curry and rice. While this may not be to the liking of many Hindu purists in the plains, its best to leave those who survive in the mountains to frame their own rules!

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Unanswered Qs:

* Is there any other temple in India where Kartik is considered the protective diety of nomads and shepherds?
* Mythology says that Kartik lost a bet to his brother, Ganesha, and destroyed himself. Does it talk of a sister named Matala-Devi who sits atop a craggy peak on the opposite side of the river?

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REFERENCES & LINKS

Manimahesh Parikrama - http://www.bharmourtreks.com/show_tour.php?tourid=3&cat=1
Kaylong Kartik Temple - Mythology - http://www.bharmourtreks.com/show_tour.php?tourid=3&cat=1

Wondering about Mt. Kailash

Pick a random place South Delhi and chances are that it is named after the 'abode of Shiva', Mt. Kailash. You have Kailash Colony, Greater Kailash-I, II, III, IV, East of Kailash and West of Kailash. Elsewhere in Delhi, you will find Kailash Apartments, Kailash Hospitals and...the list is endless.

This fondness for Kailash goes much beyond Delhi. The Buddhists say three of their main Buddhas -- Manjushree, Avalokiteshwara and Vajrapani -- all live there in the mountain. The Jains say Rishabh lives there and South Indian mysticism says their greatest yogi, Agasthiya Muni, who is the basis of South Indian mysticism and is one of the seven direct disciples of Shiva, lives in the southern face of Kailash.

How and when did this mountain located beyond the Himalayan ranges, in far-away Tibet, come to occupy such a prominent place in our imagination?

What makes Mt. Kailash truly exceptional is the fact that it lies well beyond the other popular places of worship in the Himalayas. Most of these are located along the tributaries and glaciers that feed the great rivers. But to reach Mt. Kailash, you need to travel along the Kali river valley that cuts through the breadth of the Himalayas. Then, once you are on the other side Lipulekh Pass, on the Tibetan plateau, another long trek takes you between the twin lakes Rakshas Tal and Manasarovar before you finally reach the Mt. Kailash area.

How on earth did the ancient pilgrims find their way to this mountain??

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LINKS

http://www.huffingtonpost.com/sadhguru/pilgrimage-to-kailash-the-mystical-library_b_3121912.html
Pics from - http://en.wikipedia.org/wiki/Mount_Kailash and KMVN
http://www.euttaranchal.com/tourism/adventure/kailash_mansarovar_yatra_itineary.php

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